AB1066 TREATMENT OF ACUTE CALCIUM DEPOSITS IN HAND AND WRIST WITH ANAKINRA
Authors: A. Durdzińska Timóteo, A. Dumusc, S. Durand
Journal: Annals of the Rheumatic Diseases (2022)

Background Acute calcium deposits (ACD) of hydroxyapatite in hand and wrist are a rare cause of acute pain due to crystal-induced soft tissue inflammation. There are no standard management guidelines for this condition, which is frequently treated with non-steroid anti-inflammatory drugs or steroid infiltrations with variable efficacy, some patients presenting symptoms for several months 1 . Anakinra, an interleukin-1 receptor antagonist, showed non-inferiority compared to usual care in the treatment of acute gout arthritis in a randomized controlled study 2 and demonstrated effectiveness in comorbid patients with recurrent crystal-related arthritis. Due to our local experience with anakinra to treat calcific periarthritis 3 , we started using anakinra in the treatment of selected patients with ACD in hand and wrist with severe pain. Objectives To report our experience with anakinra to treat ACD in hand and wrist in terms of efficacy and safety. Methods We retrospectively included all patients treated with anakinra for ACD in hand or wrist in our department in 2020. We extracted data on treatment duration, pain, range of motion, skin erythema, hypervascularization, oedema and X-ray findings when available. Results Ten patients (mean age 45, SD 11) were treated for ACD in hand or wrist with anakinra 100 mg per day for a mean duration of 2.7 days. We observed a fast and significant improvement of pain at rest on a 0-10 VAS scale (mean pain reduction at day 2 (SD): -3.9 (2.8), p=0.01). All patients were free of pain at rest after day 6 and at motion after day 21. Range of motion significantly improved at day 2 (+41° (24), mean (SD), p=0.03). We observed local erythema and oedema improvement from day 2 and a decrease in skin temperature from day 3. Calcifications decreased in size or disappeared in the majority of the patients. We did not observe any adverse events. Patients did not report recurrence after phone contact, 12 months after treatment. Conclusion Anakinra was associated with a significant clinical improvement after only two days of treatment of ACD in hand or wrist and may be considered to treat patients with this condition, especially those with contraindication to NSAIDs or glucocorticoids. Further controlled studies are needed to confirm our observations. References [1]Nikci V, Doumas C. Calcium deposits in the hand and wrist. J Am Acad Orthop Surg. 2015, 23: 87-94. [2]Janssen CA, Oude Voshaar MAH, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019 Jan 2. [3]Zufferey P, Valcov R, Thomas M, et al. Efficacy of anakinra in acute hydroxyapatite calcification-induced joint pain: A retrospective study of 23 cases. Joint Bone Spine. 2019, 86: 83-8. Figure 1: Graph 1. Box plot of pain at rest (0-10 VAS scale) and range of motion (ROM) at day 0, 1, 2, 3, 7 and 21 after treatment with anakinra 100 mg per day. Disclosure of Interests None declared